Polycystic ovarian syndrome (PCOS) is the accumulation of underdeveloped follicles in the ovaries due to anovulation. It is is characterized by menstrual abnormalities and clinical or biochemical features of hyperandrogenism.
It results mainly from abnormal steroidogenesis that may be caused by insulin resistance leading to hyperinsulinemia.
There is increased sensitivity to androgens and the majority of women have elevated androgen levels.

Central obesity and high BMI have a major impact on the development of hyperinsulinemia and hyperandrogenism

PCOS patients with normal body habitus should be advised to continue these and to maintain their body weight within the normal range

PCOS patients should be informed of and screened for risk factors of cardiovascular disease (CVD): Cigarette smoking, obesity, dyslipidemia, type 2 diabetes mellitus, family history of early CVD, hypertension, and obstructive sleep apnea

Diet Modification

There is no particular food plan that is recommended for PCOS

Frequent feedings (4-6x/day) may be helpful to avoid hypoglycemia and hunger

Hypoglycemia can lead to cravings and poor food choices

To promote weight loss, diet should be modified to an intake of carbohydrates with a low glycemic index, and a reduced intake of fat and simple sugars

High-protein diet appears as effective as high-carbohydrate diet, as long as fat and total calories are comparable

Exercise

Weight reduction and exercise can help reverse the metabolic problems in PCOS by improving ovarian function and the associated hormonal aberrations

Decreases risk of diabetes and CVD

Improvement in physical fitness and reduction in body fat will assist in resumption of ovulation and increase in fertility especially in anovulatory obese women with PCOS

A small cohort study presented at the Royal College of Obstetricians & Gynaecologists (RCOG) World Congress 2018 has reported a 5-year diabetic ketoacidosis (DKA) incidence rate of 4.16 percent in pregnant women with type 1 diabetes mellitus (T1DM), with generally good maternal and neonatal outcomes.